Pittsburgh B Compound Positron Emission Tomography in Patients With AL Cardiac Amyloidosis

Seung Pyo Lee, Hoon Young Suh, Sohyun Park, Sera Oh, Soon Gu Kwak, Hyue Mee Kim, Youngil Koh, Jun Bean Park, Hyung Kwan Kim, Hyun Jai Cho, Yong Jin Kim, Inho Kim, Sung Soo Yoon, Jeong Wook Seo, Jin Chul Paeng, Dae Won Sohn

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Abstract

Background: It remains unknown whether the noninvasive evaluation of the degree of amyloid deposition in the myocardium can predict the prognosis of patients with light chain (AL) cardiac amyloidosis. Objectives: The purpose of this study was to demonstrate that 11C-Pittsburgh B compound positron emission tomography (11C-PiB PET) is useful for prognostication of AL cardiac amyloidosis by noninvasively imaging the myocardial AL amyloid deposition. Methods: This study consecutively enrolled 41 chemotherapy-naïve AL cardiac amyloidosis patients. The amyloid deposit was quantitatively assessed with amyloid P immunohistochemistry in endomyocardial biopsy specimens and was compared with the degree of myocardial 11C-PiB uptake on PET. The primary endpoint was a composite of all-cause death, heart transplantation, and acute decompensated heart failure. Results: The degree of myocardial 11C-PiB PET uptake was significantly higher in the cardiac amyloidosis patients compared with normal subjects and correlated well with the degree of amyloid deposit on histology (R2 = 0.343, p < 0.001). During follow-up (median: 423 days, interquartile range: 93 to 1,222 days), 24 patients experienced the primary endpoint. When the cardiac amyloidosis patients were divided into tertiles by the degree of myocardial 11C-PiB PET uptake, patients with the highest PiB uptake experienced the worst clinical event-free survival (log-rank p = 0.014). The degree of myocardial PiB PET uptake was a significant predictor of clinical outcome on multivariate Cox regression analysis (adjusted hazard ratio: 1.185; 95% confidence interval: 1.054 to 1.332; p = 0.005). Conclusions: These proof-of-concept results show that noninvasive evaluation of myocardial amyloid load by 11C-PiB PET reflects the degree of amyloid deposit and is an independent predictor of clinical outcome in AL cardiac amyloidosis patients.

Original languageEnglish
Pages (from-to)380-390
Number of pages11
JournalJournal of the American College of Cardiology
Volume75
Issue number4
DOIs
StatePublished - 4 Feb 2020

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Keywords

  • cardiac amyloidosis
  • positron emission tomography
  • prognosis

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